Endometriosis (adenomyosis) of the uterus

Endometriosis (adenomyosis) cancer is the most frequent type of genital endometriosis. The lesion can be either congenital or develop as a result of operations on the uterus, including after frequent abortions. The main symptom in both forms of the disease is algodismenorrhea. In patients with congenital endometriosis algodismenorrhea appears with the start of metroidvania or in the first 2-3 years after menarche; often the intensity of the pain from the very beginning is pronounced. When adenomyosis, developing as a result of operations on the uterus (including frequent abortions), painful periods increases gradually.

adenomyosis (endometriosis) of the uterus
Fig. 6. Schematic representation of adenomyosis (endometriosis) of the uterus, mainly affecting its isthmus (a).
The surface of dissection of the neck of the uterus. Visible nests endometriosis (b).

Congenital endometriosis cancer may be associated with anomalies of genital and other organs that is of some diagnostic value. Pain intensity with adenomyosis depends on its form (nodular or diffuse), depth of growing into the myometrium, involving the peritoneum and the proximity of endometriosis from Sacro-uterine ligaments. The pain was stronger in nodular form compared to diffuse. But especially they are with the defeat of the isthmus of the uterus (Fig. 6), the involvement of the Sacro-uterine ligaments and endometriosis incremental horns of the uterus, when the process involved the peritoneum or menstrual blood from the horn is thrown on the peritoneum of the pelvic organs. In these patients (with endometriosis isthmus of the uterus and the extension of the horns of the uterus) the clinical picture can simulate impaired ectopic pregnancy, i.e. developing acute abdomen. Paroxysmal pain accompanied by nausea, vomiting, fainting. If you experience symptoms of peritoneal irritation. The similarity is exacerbated by the fact that out of the vagina appear dark brown discharge, and with a puncture posterior vaginal fornix get dark blood (retrograde got in utero-right-intestinal deepening). Endometriosis right incremental horns of the uterus can simulate appendicitis or ovarian apoplexy (the latter applies to the left horn).
Paroxysmal pain in endometriosis isthmus of the uterus before and during menstruation can be combined with a delay of a chair and gases, and also with the dysuric phenomena (frequent and painful urination; in the future can join hematuria).
In addition to congenital, endometriosis isthmus of the uterus may be the result of diatermokoagulyatsii cervix and frequent abortions, including complicated by perforation of the uterus in the area of the isthmus.
Some value in clarifying the localization of endometriosis in the uterus has radiation of pain. So, with the defeat of the corners of the uterus pain give appropriate groin area, endometriosis back part of the isthmus of the uterus is in the rectum.
Next in importance are the symptom of adenomyosis uterus-heavy and prolonged periods of nature menorrhagia, but can take place and metrorragiya. Uterine bleeding generous, hard, difficult symptomatic therapy and often lead to anemia. Changes in the metabolism of sex hormones, negatively affects the function of blood, contribute to this. Uterine bleeding is more pronounced in the diffuse adenomyosis cancer compared with the hub.
In addition, in the diffuse adenomyosis uterine many patients report an unpleasant feeling of heaviness and pain in the lower part of the abdomen and deep in the pelvis. Some of these patients during and in the days following the monthly increases body temperature, usually to low-grade level.
At the end of menstruation for 3-4-5 or more days can be observed dark brown vaginal discharge, which is explained by the emptying of the endometrial cavity and cracks in the uterus. The combination of endometriosis and uterine fibroids is 80-85 % of patients have symptoms of both diseases.
Our observations show that the combination of fibroids and endometriosis cancer often expressed pain syndrome (mainly due to endometriosis isthmus of the uterus in the absence of submucosal location of the site), hiperproliferarea and secondary anemia. In history in such patients were repeated determinirovannyi intervention on the cervix. The pain, hiperproliferarea often joins dysfunction of the intestine (the tendency to constipation in ordinary days before and during menstruation is replaced purgative effect of the intestine).
Objective data of the survey depend on the form of endometriosis (nodular or diffuse), its location (the isthmus or incremental uterine horn), presence of concomitant fibroids. When node uterus endometriosis may have normal size or be slightly increased. In the area of the corners of her body, or the bottom determined tight painful nodes. Before and during menstruation is the size of their few increase and the pain increases. In the diffuse adenomyosis uterine value it reaches 5-6-7-8-week pregnancy and rarely more. Clearly noticeable dependence of change of size of the uterus from the phase of the menstrual cycle. The presence of accompanying fibromyoma, of course, influences the size and shape of the uterus.
With the defeat of the isthmus of the uterus last expanded tight and painful to palpation, especially in the area of attachment Sacro-uterine ligaments. Pain more noticeable before, during and after your period. In addition, often with the defeat of the isthmus of the uterus are limited mobility of the uterus and increased pain in the displacement of the uterus forward.
Considerable aid in the diagnosis of endometriosis body and neck of the uterus can have cervico-hysterography (availability zakonchennyi shadows). However, the negative results of this method are not grounds for excluding the diagnosis of adeno-mioza of the uterus.
To improve the information value method, historical-pyrography (GHA) in the diagnosis of adenomyosis uterine N. Century Lebedev, V. I. El'tsov-Strelkov (1987) proposed for the day before the examination to be carefully scraping mucous membrane of the uterus. This measure facilitates penetration of water contrast to all the moves of endometrioid heterotopia and allows you to get zakonchennie shadows in the presence of internal endometriosis. In the informative method has increased, according to their data, more than 3 times. The authors have a match clinical, radiological and histological diagnoses in 83 %, whereas without the prior scraping mucous membrane of the uterus diagnosis of adenomyosis uterus was installed by the method of GHA only 15-20 % of the examined patients.
Introduction of the method of ultrasound also contributes to improving the diagnosis of adenomyosis of the uterus. Methods GHA and ultrasound with consideration of complaints and clinical disease should be treated as complementary, not competing.
Diagnostic curettage of the uterus suspected adenomyosis gives the opportunity to get an idea about the state of the endometrium, but for recognition of adenomyosis (endometriosis) it should not be used because we need to receive not only the mucous membrane of the uterine body and muscle tissue. Such blatant interference will contribute to the progression of the disease.